The Case of Tina and Bruce: An Introduction

I will start my recent post by presenting two clinical examples. Names are changed to maintain anonymity.

The client (Tina) enters the room to discuss her anxiety, inability to concentrate, and an overwhelming feeling that others continue to speak ill of her. These symptoms contribute to constant behavioral impediments and cognitive dysfunction. As she takes a seat in the office, I noticed her holding a 32 ounce coffee and an unopened Red Bull energy drink. As she drinks away at the coffee, she comments that this is a third coffee in the day. About 30 minutes into the session, the coffee cup sat empty while she opened the Red Bull energy drink.

In another case, the client (Bruce) brought some food into the session. He had two bags of potato chips, a machine bought confectionary pastry, and a bottle of diet coke. His major complaints involved feeling of dysphoric feeling while transitioning between euthymic, hostile, and dysthymic mood states.

In both situations, I felt compelled to inquire about the connection between dietary habits and mood. I asked Tina and Bruce to discuss frequency of consumption, amount of consumption throughout the day, and their level of physical activity. Bruce reported that his diet consist McDonald’s breakfast meal. Lunch included vending machine snacks and a diet soda. If Bruce ate dinner, he was likely to eat a cheeseburger or some form of fried fast food. Tine, on the other hand, reported significant inconsistencies with a patterned diet. She reported days that she would have one meal. However, she reported continued consumption of at least three, thirty-two ounce cups of coffee that contained additional ingredients for flavor and sweetness.

Assessing Nutrition in Context

The current post attempts to raise the question concerning the mental health clinician’s role concerning nutrition and mental/psychological well-being. In both cases, I assumed a contextual-dynamic approach to assessing and treating the clients. The approach has its grounding in a mixture psychodynamic and ecological systems theory. The psychodynamic element sought to understand the basic essence of individual impulses and drives that compels the compulsion towards repetitive behaviors. On the other hand, the ecological/engagement model take a person-centered approach to understand the method to which a person negotiates and adjusts behaviors in accordance with environmental demands (Neufeld, Rasmussen, Lopez, Ryder, and Magyar-Moe, 2006). In assessing the relationship between diet and psychological dysfunction, I am narrowing the scope of my discussion to the client’s perceived necessity to maintain dietary standards and the impact that such dietary standards has on psychological states.

All too often the everyday person proclaims, “I am no good until I have my morning coffee” or I will grab something quick to eat later”. Unfortunately, the later either never arrives or something quick refers to a meal that is highly processed, overly salted, or saturated in fat which provides family sized proportions within one meal. Tina and Bruce were no different. During multiple sessions, I noticed that caffeine, sodium, Trans fats, and processed sugars were indicative of a standardized norm within the everyday functioning of these two clients. Within my assessment, I noted Bruce’s cyclical transitions between euthymic, dysthymic, and hostile moods. I also noted Tina’s harmfully dysfunctional anxiety. Given diet and nutritional habits, I explored dietary necessity of such foods and the effects such foods have on psychological well-being.

Over the past decade, there has been an overwhelming amount of research concerning the role of nutrition and mental health. For purposes of space, I will limit to a sample exploration of literature. For a greater discussion, I have a paper forthcoming later this year. Given the U.S renewed focus on nutrition and health, research has continued to examine the influences of nutrition on health and mental health. In a review of the literature, Ta and Ladea (2012) found consistent patterns relating nutritional deficiencies to depressive symptom formation. Rao, Asha, Ramesh, Rao (2008) identified several vitamins, minerals, and fatty-acids essential in preventing mental illness. Consistent with their discussion, Stoll, Severus, Freeman, Rueter, Zboyan, Diamond,Cress, Marangell, 1999 found that Poly-Unsaturated Fatty Acids such as DHA’s can decrease the onset of depression. In addition, several studies found that patients with folate deficiencies remain at higher risk of depression (Benton, Haller, and Fordy, 1995; Abu-Selah, and Coppen, 2006; Alpert and Fava, 1997).

Tina and Bruce’s cases are indicative of the above findings. In Bruce’s case, the chronic of aspartame (typically found in diet drinks to enhance sweetness), saturated fats, sugars, and salts produces deficiencies relating to depression or lowered mood. In a 2003 report, the Food and Drug Administration reported that the use of aspartame is associated with severe depression, extreme irritability, severe anxiety attacks, marked personality changes, severe insomnia, and severe aggravation of phobias. The combination of food additives such as sweeteners/sugars and fats can have both a mood elevating and degenerating effect. Tina, on the other hand, demonstrates a chronic dependency on caffeine. The use of caffeine has been commonly attributed to fast heart rate, anxiety, depression, difficulty sleeping, nausea, restlessness, tremors, urinating more often, and vomiting. In addition, considering the lack of attention to nutrition, it is likely that Tina has a deficiency in vitamin E. Vitamin E deficiencies associate with increased stress and anxiety (Okura, Tawara, Kikusui, and Takenaka, 2009).

Final Considerations

While I am not suggesting that mental health clinicians make nutrition a focal point, I will advocate that we consider the issue within the context of psychological well-being. Of course Tina’s complaint had greater cognitive, relational, and socio-economic underpinnings. However, the over-consumption of caffeine and lack of nutritional consistency are certainly contributors to the problem. Bruce also has many other elements of concern. Unhealthy and sedentary lifestyles provides a biochemical element to the general picture.

Given our current societal structure, it is likely that such a stressful and overburdened system encourages the need for fast food, around the clock activity, stress glorification, and the continued fear of social and economic disaster propagated by the media. Tina and Bruce are agents within such a system. The constant demand for time leads Bruce to forgo appropriate meals. Tina, on the other hand, felt the need be the best version of her sense of self. This means that sleep represented a sign of weakness. As such, constant functioning became imperative.

Brian T. Jones currently practices psychodynamic psychotherapy at MassBay Community College, Framingham Campus. In addition, he teaches Philosophy and Psychology at MassBay (Wellesley) and Salem State University. His current clinical interests involve psychosocial factors of stress, health, and wellbeing with a focus on ecological systems as it relates to mental images. Finally, Brian currently conducts research concerning social perceptions of homelessness and homeless issues. Brian earned his Master’s degree for Philosophy in 2009 and Mental Health Counseling in 2012.

2 Comments Already

James Orwig-July 1st, 2014 at 9:33 amnone
Comment author #3597 on The Case of Tina and Bruce: An Introduction by Global Summit on Diagnostic Alternatives

Brian,
So the diagnosis should be Pyschopharmic Deficiency Disorder. I have been working with a client who was referred because of alcohol dependency. He had a history of growing up in a home where his father was alcohol dependent, violent towards his mother, his father died of gunshot wounds when my client was 16. His parents divorced when he was 7. His mother had a physical disability and used psychotropics to cope. He was in a car accident that killed two people, for which he spent time in prison. He did not drink until he was about 20 and was dumped by a girlfriend. Now in his 50s, alcohol was his drug of choice until he was referred to a local psychiatric nurse practitioner. She put him on anabuse to eliminate the alcohol, seroquel, because he had difficulty sleeping, abilify in the morning, xanax 3x a day for his jitteryness, prestiq for his depression. He was already taking neurotin for phantom limb pain. He lost most of his arm in an industrial accident. He tried Chantix, because he wanted to quit smoking, but the side effects were a bit much, so he gave it up. I persuaded him to quit the abilify and prestiq and he reduced the amount of xanax he took to occasionally. I see him in his home and one day I asked him how much coffee he was drinking. It was two pots, roughly a gallon and a half of coffee. We discussed the possibility that the caffeine might be the cause of his jitteryness and difficulty sleeping. He’s backed off the coffee to one pot and has cut back on his cigarettes to one pack or less a day. He’s an intelligent man, but changing old habits is slow. I attended a one day seminar sponsored by the Institute for Brain Potential and presented by Marilyn Kuhn titled Understanding the Gut Brain: Stress, Appetite, Digestion and Mood. Very Informative and it added another dimension tounderstanding behaviors.
Jim

Brian T. Jones-July 4th, 2014 at 9:31 pmnone
Comment author #3671 on The Case of Tina and Bruce: An Introduction by Global Summit on Diagnostic Alternatives

Hi Jim,

I find the topic interesting. I am glad to see others giving the issue some consideration. I, myself, started thinking about the issue when I noticed that I was increasingly jittery. I started to impede my attention. I decided to say no to the necessity of coffee in the morning. I also began to notice these issues with clients that prompted my further consideration. Certainly I think this issue is important. It really disturbs me to see such a laundry list of medications (each fighting against the other).

The shift to mindfulness, I believe, represents a step in the right direction. However, all of this work lacks the focus of balance. If we are not considering diet in the equation, I believe we are not doing our client justice. You were great to shine the light on the impact of food. I find that many people are not aware of how something as simple as coffee, candy, fast food, and other foods impact mood and emotions.